Kitwood Reconsidered

Here’s a cross-post from my weekly ChangingAging submission…

Ever since Professor Tom Kitwood coined the term “person-centred care” in the 1990s, it became a watchword of the culture change movement. Sometime after that, The Eden Alternative and others began to replace the term with “person-directed care”, which forces us to raise the bar beyond a paternalistic approach where we decide what elders need most, to actually asking them.

In recent years, many in the U.K. have moved on to a new concept: “relationship-centred care”. The rationale is that each person in a care home exists as part of a larger community where the well-being of all must be taken into consideration. A central concern raised with the older terminology is that focusing on an individual’s needs may actually infringe on the well-being of others in the community, which is also undesirable.

In actuality, that’s not just a nursing home issue. We all have to balance our autonomy with the needs of others in our environment. That’s why most of us still stop for red lights. But I’m not ready to abandon “person-directed care” yet. Here’s why:

In the traditional nursing home, there is a much more powerful barrier to individual choice than the competing needs of others, and that is the institutional structure itself. What we choose to call our style of care is a moot point if we ultimately bow to the needs of this rigid system. My concern is that simply changing our semantics to “relationship-centred care” may fail our elders because it may not provide enough impetus for us to transform the care environment as well. This is where models like Eden reign supreme: they not only promote individualized care, but they provide a framework to realize it to the fullest extent by transforming operations, in order to remove those larger barriers.

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